Simultaneous radical nephroureterectomy (RNU) with radical cystectomy (RC) has been associated with a relatively high complication rate in previous studies and reviews. However, many of these studies are limited by small case numbers and varied outcomes, which may reflect limited surgical experience with this complex procedure. Taiwan has a notably high prevalence of upper tract urothelial carcinoma (UTUC) and end-stage renal disease (ESRD) compared to Western populations. We present the long-term outcomes of robotic simultaneous RNU with RC for ESRD patients from a single high-volume institution in Taiwan.

We conducted a retrospective study of all ESRD patients who underwent simultaneous robotic RNU with RC from 2016 to 2021 in our institution. Bilateral RNU was performed for all patients unless the contralateral side had been previously excised. Our surgical team consisted of 2 experienced console surgeons and a well-trained senior resident as surgical assistant. All procedures were performed using the Da Vinci Si system with a standardized port placement and docking method. The study endpoints included total surgical time (from incision to skin suture), estimated blood loss (EBL), operative complication rates (classified according to the Clavien-Dindo classification), and oncological outcomes.

37 ESRD patients (13 males and 24 females) with a mean age of 70.2 years underwent simultaneous robotic RNU with RC during this period. Of these, 5 patients (13.5%) received left RNU, 6 patients (16.2%) received right RNU, and 26 patients (70.2%) received bilateral RNU. There were no conversions to open surgery or operative mortality. The median EBL was 359ml and the average operation time was 539 minutes. Clavien-Dindo class 3 or higher complications occurred in 4 patients (10.8%). The average length of admission was 12days, with only 1 patient readmitted within 30 days post-discharge due to paralytic ileus. Over a median follow-up period of 53.3 months, disease progression was observed in 6 patients (16.2%), and the 3-year survival rate was 83.8%.

In our study of ESRD patients undergoing simultaneous robotic RNU and RC, we observed a lower rate of severe complications compared to previous studies. These results suggest that, in the hands of experienced surgeons, the benefits of this complex procedure may outweigh its perioperative risks.